Care Home: Marray House

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What the care home does well The manager designate and staff have undertaken an assessment of all the people using the service to identify their needs and this is documented to be used to inform the care planning process. The manager designate has accessed a medication trolley for use in the home. This will enable a more organised and safe means to administer medication. This trolley must be secured to the wall at whatever location it is to be stored in. Further development of medication training and storage of medication has been organised and is awaiting completion. This will be reviewed at the next inspection. The manager designate has identified a need for a ground floor office and is currently using a vacant bedroom for this purpose. This will provide a more suitable place for the storage of records and a place for visiting health professionals and visitors to access the management of the service out of the public area. Medications stored in the kitchen food fridge are still stored unsecured but are now monitored to ensure that the correct temperature for their storage is maintained. The manager designate has now accessed the provision of two way radios for waking and sleeping staff to use in the possible event of an emergency. This will enable contactbetween the staff members without staff having to leave the scene of the emergency. What the care home could do better: We had made a previous immediate requirement around care planning and the management of the home are required to update and review all care plans, risk assessments and documentation for each person to ensure that staff have clear plans of care to follow to enable the needs of people using the service to be met. Timescale for the Immediate Requirement is 3rd September 2010. We had received verbal assurances that this area was being addressed to ensure the timescale would be met. At this inspection we found that only four out of the twelve people using the service had a completed and updated care plan in place. We reviewed one of these care plans and found that whilst it was an improvement on the previous records kept, it was not sufficiently detailed or person centered to enable staff to have a complete view of the persons needs. There is no evidence of the input of the person or their representative to ensure that peoples choices are identified. Further development of care planning is needed to ensure that they are person centered and support the people using the service preferences and choices. It is disappointing to note that despite ongoing support the timescale could not be met. We discussed the reasons for this with the manager designate and agreed a timescale extension until the 28th September 2010 for completion of all care plans. We looked at how hot water outlets are managed and monitored to ensure that there is no risk of burns and scalds to people using the service. We identified that not all hot water outlets have in place a thermostatic valve controller to ensure the water is delivered at a safe temperature. Therefore is is extremely important that until such a time as the TVC are fitted, the hot water outlets are monitored regularly to ensure that the temperature is both sufficient and does not exceed the health and Safety upper limits for hot water delivery. Records provided showed that not all hot water outlets are monitored. The bath temperature is recorded by staff before use but hand basins are not checked. This is to be reviewed by the manager designate and routine checks are undertaken and appropriate action taken to ensure that people are not placed at risk of burns and scalds. We discussed with the manager designate staff training and how this was to be accessed. the Service Improvement Team are supporting the home to ensure that training for staff is accessible. We advised that a matrix is undertaken to provide an overview of the training completed by all staff to enable any gaps to be met with the appropriate training.It became evident that the manager designate does not have a clear understanding of the Safeguarding Vulnerable Adults process and as such may place people using the service at risk. The manager designate must undertake the safeguarding training and ensure that staff are also provided with this training to meet the needs of people using the service. Random inspection report Care homes for older people Name: Address: Marray House 12-14 Essa Road Saltash Cornwall PL12 4ED zero star poor service 26/04/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Gail Richardson Date: 1 3 0 9 2 0 1 0 Information about the care home Name of care home: Address: Marray House 12-14 Essa Road Saltash Cornwall PL12 4ED 01752844488 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Enid Robertson Crofts,Mr Peter William Crofts Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 23 Number of places (if applicable): Under 65 Over 65 23 old age, not falling within any other category Conditions of registration: Date of last inspection Brief description of the care home 0 0 3 0 8 2 0 1 0 Marray House is registered to provide personal care and accommodation for up to 23 older persons. It is a detached house situated near the centre of Saltash, close to the shops, public transport and community facilities. Peoples bedroom accommodation is provided on the ground and first floors. Stair lifts are provided to assist peoples mobility. Two Communal lounge/dining rooms , kitchen and laundry areas are provided on the ground floor. Mrs Crofts has been registered as a care provider for 28 years. The fees range from 314.25 to 325 pounds per week and the fees do not include hairdressing, chiropody and newspapers. A brochure is provided for those wanting Care Homes for Older People Page 2 of 14 Brief description of the care home more information about the home and its facilities. Care Homes for Older People Page 3 of 14 What we found: This was an unannounced inspection, which took place over two hours, on the 13th September 2010 by Compliance Inspector Gail Richardson. At this inspection a member of the Service Improvement Team was also attending. For the purpose of this inspection the term We will be used when referring to the Care Quality Commission. The last key inspection took place on the 15th and 26th April 2010. A further random inspection took place on the 2nd July 2010. At that time we looked at areas relating to risk assessment, care planning and medication practice. We found that none of the statutory requirements relating to these areas had not been addressed or met within the timescale stated. On the 3rd August 2010 we visited the home to follow up on the same requirements made relating to risk assessment, care planning and medication management to establish the actions the home has taken to meet the outstanding requirements. We found that none of the statutory requirements relating to the areas assessed had been fully addressed or met within the timescale stated. We issued three immediate requirements about care planning, medication management and recruitment procedures. On the 23rd August 2010 a random inspection was undertaken to look at how the management of the home had addressed these immediate requirements. We found that some improvements had been made to medication arrangements and recruitment. This inspection was undertaken to look at how care plans had been updated to include appropriate information and a clear plan of care for staff to follow. There are currently 12 people using the service. On duty were the manager designate and two care staff. The two care staff were also covering duties in the laundry and the kitchen. What the care home does well: The manager designate and staff have undertaken an assessment of all the people using the service to identify their needs and this is documented to be used to inform the care planning process. The manager designate has accessed a medication trolley for use in the home. This will enable a more organised and safe means to administer medication. This trolley must be secured to the wall at whatever location it is to be stored in. Further development of medication training and storage of medication has been organised and is awaiting completion. This will be reviewed at the next inspection. The manager designate has identified a need for a ground floor office and is currently using a vacant bedroom for this purpose. This will provide a more suitable place for the storage of records and a place for visiting health professionals and visitors to access the management of the service out of the public area. Medications stored in the kitchen food fridge are still stored unsecured but are now monitored to ensure that the correct temperature for their storage is maintained. The manager designate has now accessed the provision of two way radios for waking and sleeping staff to use in the possible event of an emergency. This will enable contact Care Homes for Older People Page 4 of 14 between the staff members without staff having to leave the scene of the emergency. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 5 of 14 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 Risk assessments must be 20/05/2010 undertaken for each person in relation to diabetes, self administration of medication and moving and handling (where appropriate). Following those assessments appropriate action must be taken to ensure that people are kept safe 2 7 15 The registered person must ensure that all areas of identified need have an appropriate plan of care for staff to follow . This will ensure that staff are aware of all care to be provided. This will also provide a clear audit of all care given. 20/05/2010 3 9 13 The home does not have 21/05/2010 suitable storage for controlled medications and is advised to address this with secure and appropriate storage This will mean that should the storage be required at short notice the facility is readily available. Care Homes for Older People Page 6 of 14 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 4 9 13 All prescribed creams must be stored correctly at the right temperature and for their shelf life only. Medications prescribed for one person must not be re appropriated to another person. To remove labels and write names on boxes, may place people at risk of harm 21/05/2010 5 9 13 The registered manager must ensure that all medications which are given to epople for self administration are recorded. This is required to ensure that there are records of medications provided and will provide a clear audit trail of medications taken. 21/05/2010 6 9 13 The registered person must ensure that medications are signed for correctly. This will mean that procedures are correctly folowed and medication adminstered safely 20/05/2010 7 9 13 When staff are required to hand transcribe medications onto the administration record, that two staff sign the record. This will ensure that there is no risk of error in transcribing. 20/05/2010 Care Homes for Older People Page 7 of 14 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 8 12 16 The registered person is required to ensure that a programme of activities is planned for the recreation and enjoyment of people using the service. The programme is required to include social interaction for all people using the service at a level of their participation and enjoyment. 17/09/2009 9 19 12 The registered person is 20/11/2009 required to implement a repair / refurbishment programme to all areas of the home needed repair. This is with particular reference to all of the bathrooms / shower room which pose the risk of cross infection. This is required to ensure the maintenance of an environment which is safe for use by people using the service. 10 29 18 The registered person must 20/05/2010 ensure that all recruitment checks are in place prior to staff starting work at the home. This would include and recent photograph, that all documents are signed and dated when received. That a full and detailed employment history is obtained with reasons for leaving the last employer and that Protection of vulnerable adults checks are received prior to the staff member starting work. Page 8 of 14 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action This s required to ensure that people using the service are kept safe from harm 11 30 18 The registered person must ensure that staff training is provided for all staff to ensure that they remain updated on current good practice. This is needed to ensure that people using the service receive a good standard of care which promotes their safety and wellbeing. 12 31 12 The provider/manager is 21/05/2010 required to undertake audits of the home with relation to risk assessment, care planning, medications and recruitment. This is required to ensure that the quality of service is safe. 13 33 26 The registered person is required to undertake a visit to the home at least once a month and produce a report to be forwarded to the Care Quality Commission reviewing the areas outlined in this regulation. This is required to enable the registered person to have an overall view of the quality of the care provided. 14 38 12 The registered person must 21/05/2010 Page 9 of 14 22/10/2009 21/05/2010 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action ensure that hot water outlets are monitored and that they do not exceeded the health and safetys guidance on upper limits. This is required to ensur ethat people using the service are not at risk of burns and scalds. 15 38 12 The registered person is required to ensure that all substances hazardous to health are stored securely. This is required to ensure that there is no risk of accidental ingestion. 21/05/2010 Care Homes for Older People Page 10 of 14 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 18 12 The registered manager is required to ensure that all staff receive training in abuse awareness and protection of vulnerable adults to ensure the safety of people using the service. This will ensure that people using the service are safe form the risk of abuse 29/10/2010 2 18 12 The registered person is 15/10/2010 required to update the homes safeguarding adults policy to reflect current practice. Access to the local safeguarding policy will inform staff of the actions to be taken should an allegation of abuse be made. Care Homes for Older People Page 11 of 14 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 The registered person is recommended to include within the pre admission assessment peoples choices and preferences of social interests, hobbies, religious and cultural needs. This will enable the manager to make an informed decision if the persons needs can be met by the service. The registered person is recommended to ensure that all identified care needs noted in the re admission assessment are transfered to the care plan so that peoples needs are met. The registered person is recommended to include sufficient detail within each care plan to ensure that they are person centered and people receive their specific choices and preferences. Some medications are stored in the food fridge and are identified but not secured. This is recommended to be addressed to ensure the safe storage of all medications. Creams stored in peoples rooms are not consistently signed for when administered, this is needed to ensure a clear audit trail of prescribed medications. Creams in peoples rooms are also not dated when opened. This is needed to ensure that the creams shelf life when opened is not exceeded. It is evident that people at the home do not have the facility to lock their bedroom doors or have lockable storage for personal items. The registered manager is recommended to provide means to store securely any personal items. The registered person is recommended to ensure that cleaning is recommended to be undertaken to ensure a good standard of hygiene in the kitchen. The registered person is recommended to record how staff are supervised and by whom when they start work with a Protection of Vulnerable Adults check in place but the Criminal Record Bureau check has not yet been received. The registered person is recommended to provide an overview of staff training to identify any shortfalls in training updates and enable appropriate training to be provided. 2 7 3 7 4 8 5 9 6 14 7 15 8 29 9 29 Care Homes for Older People Page 12 of 14 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 10 29 The registered person is strongly recommended to ensure that staff recruitment files contain a contract of employment, job specification, interview record and medical history. A clear photograph of the staff member is also needed. We observed that the home does not display a copy of the last inspection report to enable people to read the outcomes from the last inspection. This is required to happen and the home is recommmeded to to put a copy on display. The registered person is recommended to ensure that quality assurance audits are used to promote changes to reflect the opinion of people using the service. The registered person is recommended to ensure that regular supervision of staff is undertaken and recorded to ensure that staff are up to date with the running of the home and promote safe working practice. The registered person is recommended to ensure that boilers are not accessible to people using the service and public visiting the home. This is recommended to prevent people altering the temperature of hot water delivery. The registered person is recommended to risk assess all free standing units and ensure that any tip risk is addressed. The registered person is recommended to ensure that toiletries left in bathrooms are not shared to reduce the risk of cross infection. 11 31 12 33 13 36 14 38 15 38 16 38 Care Homes for Older People Page 13 of 14 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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